ASOURCE Times

The only countermeasure is the vaccine

Nosocomial infection control at medical institutions is the basis of medical safety. Due to the spread of the new coronavirus infection, its importance has become widely recognized not only by medical personnel but also by the general public. At our hospital, we have invested a lot of human resources and expenses for many years to achieve results in order to prevent nosocomial infections. Before talking about nosocomial infection control, let's talk about the infection of the new coronavirus.

The infectious power of the new coronavirus and the mortality rate of infectious diseases caused by it are higher than those of influenza, and it is hoped that it will end as soon as possible. The mortality rate is 0.1% or less for influenza, while the new coronavirus is 1.8% in Japan and 2.2% in the world, which is an order of magnitude higher. Influenza is 1.3, while the new coronavirus is 1.4 to 2.5, which is higher than influenza. increase.

Infection with the new coronavirus is still widespread and we believe it will take some time to converge. There are five anti-influenza drugs for influenza: Tamiflu, Relenza, Inavir, Rapiacta, and Zofluza. If a person who develops an infection takes it within two days, or if it is injected or infused, the virus will not increase in the body, so the period of fever will be shorter and the risk of infecting the surroundings will be lower. However, drugs specific to the new coronavirus have not yet been developed, and the only countermeasure is vaccines, and the only way to prevent infection in society as a whole is to increase the number of people who receive the vaccine.

This new coronavirus vaccine has been shown to be more effective than previous vaccines. For example, in influenza, the effective rate of the vaccine is 40 to 60%, but the vaccine of the new coronavirus is excellent at 95%. In the future, if the inoculation rate rises, it is expected that the number of infected people and the number of severely ill people will decrease. And if an anti-coronavirus drug is developed, we will be able to see the way to the end.

Team medical care for infectious disease control

Next, I would like to talk about measures against nosocomial infections at our hospital. I was assigned to our hospital in August 2007, and in January 2013, I had a new clinical department called the Infectious Diseases Department. Until then, the Infection Control Department played a central role in preventing nosocomial infections. I think that infection control includes "aggressive infection control" and "defensive infection control", and it is only with these two wheels that the safety of patients and medical staff can be protected, and with the understanding of the board of directors, etc. , Realized a new system.

Aggressive infection control is the treatment of infectious diseases, such as by removing microorganisms from the patient's body. Medical care by the Department of Infectious Diseases is a major pillar, but activities by the Antimicrobial Stewardship Team (AST) are also important. AST is a team that appropriately manages and supports the use of antibacterial drugs for patients in each clinical department in order to prevent the development and spread of resistant bacteria due to inappropriate use of antibacterial drugs and long-term administration. On the other hand, defensive infection control is an activity to prevent in-hospital infection of microorganisms led by the Infection Control Team (ICT), and it is appropriate to grasp the infection trend of the entire hospital at an early stage and take measures against infection. It is managed in.

The AST is led by an Infection Control Doctor (ICD) and a team of pharmacists, clinical laboratory technicians, and Infection Control Nurses (ICNs). Similar members of ICT are teams, and many are also members of AST. At our hospital, these two teams work closely together to understand the status of antibacterial drug use, raise awareness and intervention in appropriate use, survey hospital-acquired infections, thoroughly implement hand hygiene and standard preventive measures, and infectious disease outbreaks in the hospital. Early detection and response, consultation from inside and outside the hospital, preparation of infection control manuals, etc.

In this way, AST and ICT are the basis of measures against nosocomial infections, but in recent years, the importance has been pointed out in the Diagnostic Stewardship advocated by the World Health Organization (WHO) in 2015. .. It is defined as coordinated guidance and intervention to make a better microbial diagnosis for infectious disease treatment decisions. It is an activity that can be said to be the basis for the treatment of infectious diseases and the proper use of antibacterial drugs, and it will be a collaborative work of multiple occupations centered on clinical laboratories. At our hospital, we were among the first to set up an "infection testing room" in the infection control department independently of the central clinical testing department, and are working on prompt and rigorous scientific evidence-based infectious disease treatment and infection control.

It is important that the hospital and the community always cooperate

In this way, team medical care is essential for infectious diseases, and in order to treat patients who have developed infectious diseases and prevent the outbreak and spread of infectious diseases in the hospital, both the organization and members are constantly informed. We have a system that allows us to make small turns.

Coronavirus infections put a lot of strain on medical institutions, but some are by-products. One is that infection prevention measures have become widespread among hospital staff. Before that, it was difficult to thoroughly inform people about hand hygiene and wearing personal protective equipment. In addition, almost all clinical departments are actively requesting consultations for inpatients who have developed infectious diseases. This leads to early detection and response to infectious diseases. I feel that team medical care has been further strengthened as all clinical departments have come together to work on infectious disease control.

The Infection Control Department also plays a central role in regional cooperation for nosocomial infection control. In addition to holding conferences with 10 local hospitals that make up the network six times a year, we also inspect specimens from affiliated hospitals and provide advice on treatment policies based on diagnosis.

Human resource development is also important for long-term treatment of infectious diseases and measures against nosocomial infections. Aichi Medical University has a graduate school of clinical infectious disease studies, and as an instructor, I have trained doctors who can stand alone. So far, two professors have been appointed to Wakayama Medical University and Kochi University from here. It is my pride and the pride of the university to produce professors of national and public universities from private medical universities in Aichi prefecture.